Legally Speaking: Weak link in chain of command leads to $23 million settlement

Dawn Collins, JD, is an attorney specializing in medical malpractice in Long Beach, California. She can be reached at [email protected].

Weak link in chain of command leads to $23 million settlement

A 34-year-old Illinois woman was admitted to a hospital in labor at term. She was diagnosed with hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome), with systolic blood pressures periodically in the 160–170 range. Following delivery, she still had periodic hypertension and decreased platelet levels. Although antihypertensive medication was administered, she suffered an intracranial hemorrhage. She was then transferred to another hospital for cranial decompression surgery. She suffered an anoxic encephalopathy and is now quadriplegic, aphasic, ventilator-dependent, and dependent on a G-tube for feeding.

In the woman’s lawsuit her attorneys faulted the individual obstetrician for failing to aggressively treat the high blood pressure and low platelet levels. They also claimed that the hospital’s nurses and supervisors were negligent for failing to follow the chain of command to obtain appropriate medical care.

The verdict

The case was settled for $23 million, with $22 million from the hospital and $1 million from the physician.

Analysis

Most hospitals have a chain-of-command policy that is used when emergency medical care is needed, either due to the absence of a physician or when a physician is not responding appropriately to the patient’s symptoms. A good policy should include not only who should be notified and in what order, but also the situations in which it will be employed.

In malpractice cases allegations of a failure to follow the chain-of-command policy often are made retrospectively, knowing the bad outcome and claiming that nurses had a responsibility to obtain additional medical care that would have prevented the patient’s injury. All caregivers should be aware of the requirements and situations in which their hospital’s chain-of-command policy should be employed.

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